Anticompetitive consolidation and underinvestment in primary care are hurting public health, Shawn Martin, the executive vice president and chief executive officer for the American Academy of Family Physicians said in a June 8 statement to the Senate Committee on Finance.
"Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes, leading the National Academies of Sciences, Engineering, and Medicine to call it a common good," Mr. Martin wrote.
Not all consolidation is bad, Mr. Martin explained, but vertical consolidation in many cases can lead hospitals and payers to use primary care to essentially check a box and then redirects funding for it into other areas.
On top of that, "systemic underinvestment" and rising costs have also made it more difficult for primary care physicians to practice independently, he noted.
Both options are making primary care a difficult area of medicine to sustain, Mr. Martin said.
"Physicians are often forced to choose between the stability offered by health systems, payers, or other physician employers, and the autonomy and community focus of independent practice," he wrote. " Increasingly, family physicians report that independent practice is simply unsustainable. The available evidence supports their experiences: our current environment is driving and rewarding consolidation while at the same time draining resources from primary care."
To bolster needed support for primary care as a whole, he urged Congress to consider acting on the following points:
- Increase funding for loan forgiveness programs for primary care physicians.
- Address unsustainable FFS payment rates for physicians.
- Permanently raise Medicaid payment rates for primary care services.
- Provide oversight into how value-based payment is used to invest in primary care, rather than in other areas of healthcare business.
- Allow the Center for Medicare and Medicaid Innovation to have additional flexibility in how it evaluates the success of primary care models.
- More transparency and antitrust statutes should be implemented to reduce anticompetitive consolidation.
- Further site neutral payment, billing transparency and price transparency legislation to support independent practices rather than incentivize consolidation.
"The AAFP increasingly hears from family physicians that their employers – whether they are health systems, health insurers, or another type of employer – are using primary care as a management tool and are failing to reinvest financial gains into their primary care practices and clinicians," Mr. Martin wrote. "This prevents primary care practices from reaping the full benefits of APM participation, including practice improvements that can advance quality and bolster patient health outcomes."